title: Mechanisms of chronic cardiac allograft rejection.
abstract: Chronic rejection in the form of cardiac allograft vasculopathy is one of the major factors that affects long-term graft and patient survival after heart transplantation. Whereas multiple factors contribute to the development of cardiac allograft vasculopathy, immunologic mechanisms play the predominant role in the chronic rejection process, because both alloimmune and autoimmune responses are causal factors. In addition, many nonimmune donor and recipient factors also affect the development of cardiac allograft vasculopathy, including hyperlipidemia, cytomegalovirus infection, baseline coronary artery disease, and the mechanism of brain death in the donor. Modern immunosuppression maintenance therapies have the potential to limit the development of cardiac allograft vasculopathy in the long term. Further research initiatives are needed to identify patient-specific immunosuppressive drug regimens and to elucidate factors that contribute to the chronic rejection of cardiac transplant allografts.
authors.affiliation: Division of Cardiovascular Surgery (Drs. Costello and Nath), Children's National Medical Center, Washington, DC 20010; and Departments of Surgery and Pathology & Immunology (Dr. Mohanakumar), Washington University School of Medicine, St. Louis, Missouri 63110.
authors.forename: John P
authors.initials: JP
authors.lastname: Costello
authors.forename: Thalachallour
authors.initials: T
authors.lastname: Mohanakumar
authors.forename: Dilip S
authors.initials: DS
authors.lastname: Nath
mesh_terms: D000818:Animals; D002908:Chronic Disease; D003324:Coronary Artery Disease / Q000276:immunology* / Q000517:prevention & control; D006084:Graft Rejection / Q000276:immunology* / Q000517:prevention & control; D006085:Graft Survival; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents
keywords: Arteriosclerosis/etiology; alloimmunity; autoimmunity; brain death; graft rejection, chronic/immunology/prevention & control; heart transplantation/immunology/mortality/trends; immunity, cellular; vasculopathy/cardiac allograft/cardiac transplant